Author:
Ponce Stephanie A.,Wilkerson Miciah,Le Randy,Nápoles Anna María,Strassle Paula D.
Abstract
Abstract
Background
Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed.
Methods
We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020–2/2021 (baseline) and 8/16/2021–9/9/2021 (6-month follow-up). Participants were asked “Since the start of the pandemic, was there any time when you did not get medical care that you needed?” Those who responded “Yes” were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system).
Results
Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04–1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28–1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17–2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00–1.56).
Conclusions
Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference57 articles.
1. Factsheet: State action related to delay and resumption of “elective” procedures during COVID-19 pandemic. American Medical Association. 2020. https://www.ama-assn.org/system/files/2020-06/state-elective-procedure-chart.pdf. Accessed 12 May 2023.
2. Czeisler MÉ, Marynak K, Clarke KE, Salah Z, Shakya I, Thierry JM, et al. Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020. Morb Mortal Wkly Rep. 2020;69(36):1250–7.
3. Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I. Centers for Medicare & Medicaid Services. 2020. https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf. Accessed 10 May 2023.
4. Gonzalez D, Karpman M, Kenney GM, Zuckerman S. Delayed and forgone health care for nonelderly adults during the COVID-19 pandemic. Urban Institute. 2021. https://www.urban.org/research/publication/delayed-and-forgone-health-care-nonelderly-adults-during-covid-19-pandemic. Accessed 10 May 2023.
5. Hamel L, Kearny A, Kirzinger A, Lopes L, Muñana C, Brodie M. Kaiser Family Foundation. KFF Health Tracking Poll - June 2020. https://www.kff.org/report-section/kff-health-tracking-poll-june-2020-social-distancing-delayed-health-care-and-a-look-ahead-to-the-2020-election/. Accessed 10 May 2023.